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Decisions about diagnostic categories through clinical practice guidelines (CPGs) represent a central type of informal policy-making which affect the scope of publicly-regulated health services and directions for future research. We examine the development of three diverse sets of CPGs for chronic fatigue syndrome (CFS) in the United Kingdom, Canada, and Australia in order to examine diverse approaches to the development of such guidelines by medical professionals and other ‘experts’ in concert with inputs from the public, particularly those affected by the disease condition. We argue that the CPGs formulated for CFS in the United Kingdom, Australia, and Canada reflect three contrasting modes of policy development, and that the differential levels of acceptance of these guidelines by a range of relevant parties provide guidance as to which mode of policy development is likely to be most effective and acceptable particularly in the domain of controversial or contested domains within medicine.